﻿<%@ Page Language="C#" MasterPageFile="~/travel-insurance/proposalforms/TravelInsuranceProposalMasterPage.master"
    Async="true" AutoEventWireup="true" CodeFile="eq_proposal_form.aspx.cs" Inherits="travel_insurance_proposalforms_eq_proposal_form" %>

<%@ Register Src="~/controls/usrPhoneNo.ascx" TagName="usrPhoneNo" TagPrefix="uc1" %>
<%@ Register Src="~/controls/usrDate.ascx" TagName="usrDate" TagPrefix="uc2" %>
<%@ Register Src="~/controls/usrIdType.ascx" TagName="usrIdType" TagPrefix="uc3" %>
<%@ Register Src="~/controls/usrIdNumber.ascx" TagName="usrIdNumber" TagPrefix="uc4" %>
<%@ Register Src="~/controls/usrCompanyLogoByServices.ascx" TagName="usrCompanyLogoByServices"
    TagPrefix="uc5" %>
<%@ Register Src="~/controls/usrSalutation.ascx" TagName="usrSalutation" TagPrefix="uc6" %>
<%@ Register Src="~/controls/usrNationality.ascx" TagName="usrNationality" TagPrefix="uc7" %>
<%@ Register Src="~/controls/usrGender.ascx" TagName="usrGender" TagPrefix="uc8" %>
<%@ Register Src="~/controls/usrRelationship.ascx" TagName="usrRelationship" TagPrefix="uc9" %>
<%@ Register Src="~/controls/usrTraveller.ascx" TagName="usrTraveller" TagPrefix="uc10" %>
<%@ Register Src="~/controls/usrNoJS.ascx" TagName="usrNoJS" TagPrefix="ucNoJS" %>
<%@ Register Src="~/controls/usrCXAds.ascx" TagName="usrCXAds" TagPrefix="ucAds" %>
<asp:Content ID="Content1" ContentPlaceHolderID="ContentPlaceHolder1" runat="Server">

    <script src="../../controls/CE_Date.js" type="text/javascript"></script>

    <script src="../../controls/IdNumber.js" type="text/javascript"></script>

    <script src="../../includes/PostCode.js" type="text/javascript"></script>

    <div id="container">
        <div id="nav_top">
            <div class="left pad_8yr">
                <a href="/travel-insurance/TAresultsquotesOne.aspx" onclick="return confirm('Are you sure to go back?');">
                    <img src="/images/forms_proposal/button/back.png" alt="Back" /></a></div>
            <div class="right pad_8yr">
                <img src="/images/forms_proposal/nav/logo_comparexpress.png" alt="CompareXpress" /></div>
        </div>
        <ucNoJS:usrNoJS ID="usrNoJS1" runat="server" />
        <asp:ScriptManager ID="ScriptManager1" runat="server">
        </asp:ScriptManager>
        <div id="divContent">
            <div id="contentBody">
                <div id="header">
                    <div class="seperator">
                    </div>
                    <div class="right" style="width: 240px">
                        <div class="quotesum_button">
                            <img src="/images/forms_proposal/button/quotesum.png" width="240" height="73" alt="Quote Summary" /></div>
                    </div>
                    <h1>
                        Online Travel Insurance Proposal Form -
                        <asp:Label ID="lblProvider" runat="server"></asp:Label></h1>
                    <div class="seperator">
                    </div>
                    <div class="quotesum">
                        <div class="top">
                        </div>
                        <div id="divQuoteSummery" class="body pad_15x">
                            <!-- QUOTE SUMMARY | Start -->
                            <div class="w21per left pad_25xr">
                                <h1>
                                    Quote Reference Number</h1>
                                <p>
                                    <asp:Label ID="lblQref" runat="server"></asp:Label></p>
                                <h1>
                                    Type of Travel:</h1>
                                <p>
                                    <asp:Label ID="lblCoverageType" runat="server"></asp:Label><asp:Label ID="lblCover"
                                        runat="server" Visible="false"></asp:Label><asp:Label ID="lblCoverage" runat="server"
                                            Visible="false"></asp:Label>
                                </p>
                            </div>
                            <div class="w21per left pad_25xr">
                                <h1>
                                    Country Traveling to (one or furthest):</h1>
                                <p>
                                    <asp:Label ID="lblDestination" runat="server"></asp:Label><asp:Label ID="lblTrip"
                                        runat="server" Visible="false"></asp:Label></p>
                                <h1>
                                    Period of Insurance:</h1>
                                <p>
                                    <asp:Label ID="lblPeriodOfCoverage" runat="server"></asp:Label>
                                    <asp:Label ID="lblDuration" runat="server" Visible="false"></asp:Label><asp:Label
                                        ID="lblStart" runat="server" Visible="false"></asp:Label><asp:Label ID="lblEnd" runat="server"
                                            Visible="false"></asp:Label>
                                </p>
                            </div>
                            <div class="w21per left pad_25xr">
                                <h1>
                                    Type of Plan:</h1>
                                <p>
                                    <asp:Label ID="lblPolicyType" runat="server"></asp:Label><asp:Label ID="lblAdultAge"
                                        runat="server" Visible="false"></asp:Label><asp:Label ID="lblChildAge" runat="server"
                                            Visible="false"></asp:Label>
                                </p>
                                <h1>
                                    No. of Traveller/s:</h1>
                                <p>
                                    <asp:Label ID="lblNoOfTravellers" runat="server"></asp:Label><input id="inNoOfTravellers"
                                        runat="server" type="hidden" /></p>
                            </div>

                            <script type="text/javascript">
                                IncreaseProgress(20);
                            </script>

                            <div class="w21per left pad_25xr">
                                <h1>
                                    &nbsp;</h1>
                                <p>
                                    &nbsp;</p>
                                <h1>
                                    Total Premium (w/ GST):</h1>
                                <p>
                                    <asp:Label ID="lblTotalPremium" runat="server"></asp:Label></p>
                            </div>
                            <!-- QUOTE SUMMARY | End   -->
                        </div>
                        <div class="bottom">
                        </div>
                    </div>
                </div>
                <div class="seperator">
                </div>

                <script type="text/javascript">
                    IncreaseProgress(25);
                </script>

                <div id="body">
                </div>
                <div id="divValidationSummary">
                    <asp:ValidationSummary ID="vstravelinsurance" runat="server" CssClass="errorSummary"
                        ValidationGroup="travel_insurance" HeaderText="Oops please complete the form" />
                </div>
                <div class="form">
                    <div class="top">
                        <div class="left">
                            <div class="pad_10t pad_35xl white">
                                Online Travel Insurance Proposal Form</div>
                        </div>
                        <div class="right">
                        </div>
                    </div>
                    <div class="body">
                        <div class="inner">
                            <div class="pad_20x10y">
                                <div class="norm">
                                    <div class="top_t">
                                    </div>
                                    <div class="body">
                                        <div class="pad_15x">
                                            <p>
                                                <b>Important Notice: </b>
                                                <br />
                                                1. Under Section 25(5) of the Insurance Act (Cap. 142), or any subsequent amendments
                                                thereof, you must disclose in this application form, fully and faithfully, all the
                                                facts which you know or ought to know in respect of the risk proposed; otherwise
                                                the policy issued hereunder may be void.
                                                <br />
                                                2. No insurance is in force until this Proposal has been accepted by the Company.
                                                <br />
                                                3. Please note that this insurance is subject to the premium being paid and received
                                                in full by the Company  <br />(a) before the inception date where the policy is issued
                                                to an individual; or  <br /> (b) within the period specified in the Premium Warranty applied
                                                to the policy in all instances, failing which there will be no liability under this
                                                cover.
                                                <br />
                                                <span style="color: Red; font-weight: bold;">**</span> Main insured must be a Singapore
                                                resident, Singapore PR or Work Permit Holder and be at least 18 years of age.
                                            </p>
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>
                                <div class="hilite">
                                    <div class="top">
                                    </div>
                                    <div class="body_in pad_15x">
                                        <h1>
                                            Customer Personal Details</h1>
                                        <div class="seperator">
                                        </div>
                                        <div class="w43per left">
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Salutation:</div>
                                                <div class="left">
                                                    <uc6:usrSalutation ID="ddlSalutation" runat="server" ValidationGroup="travel_insurance" />
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Surname:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtSurname" runat="server" Width="200px"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvSurname" runat="server" ControlToValidate="txtSurname"
                                                        CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Given/First Name:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtFirstname" runat="server" Width="200px"></asp:TextBox>
                                                    <asp:HyperLink ID="hplEditProfile" Visible="false" NavigateUrl="~/User/EditProfile.aspx?redir=~/travel-insurance/applicants_details.aspx"
                                                        Font-Size="Smaller" Text="Edit Profile" runat="server"></asp:HyperLink>
                                                    <asp:RequiredFieldValidator ID="rfvFirstname" runat="server" ControlToValidate="txtFirstname"
                                                        CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> E-mail:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtEmailAddress" runat="server" Width="200px"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvEmailAddress" runat="server" ControlToValidate="txtEmailAddress"
                                                        Display="Dynamic" CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revEmailAddress" runat="server" ControlToValidate="txtEmailAddress"
                                                        CssClass="validationErrorControl" ErrorMessage="" ValidationExpression="\w+([-+.']\w+)*@\w+([-.]\w+)*\.\w+([-.]\w+)*"
                                                        ValidationGroup="travel_insurance"></asp:RegularExpressionValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Nationality:</div>
                                                <div class="left">
                                                    <uc7:usrNationality ID="ddlNationality" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                </div>
                                            </div>
                                        </div>
                                        <div class="w56per left">
                                            <asp:UpdatePanel ID="UpdatePanel1" runat="server">
                                                <ContentTemplate>
                                                    <div id="divPostCode">
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Postcode:
                                                        </div>
                                                        <asp:TextBox ID="txtPostCode" size="8" onkeypress="restrictToNumbers(event)" AutoPostBack="true"
                                                            OnTextChanged="txtPostCode_TextChanged" runat="server" MaxLength="6" Width="80px"></asp:TextBox>
                                                        <asp:ImageButton ID="ibtPostCode" runat="server" CssClass="button" align="absmiddle"
                                                            OnClick="ibtPostCode_Click" Width="108" ValidationGroup="PostCode" AlternateText="Get Address"
                                                            ImageUrl="~/images/forms_proposal/button/getaddress.png" />
                                                        <asp:UpdateProgress runat="server" ID="uplUpProgress" DisplayAfter="500">
                                                            <ProgressTemplate>
                                                                <span style="position: absolute; text-align: right; width: 390px;">
                                                                    <img src="../../images/loading7.gif" id="ldPostCode" alt="loading" />
                                                                </span>
                                                            </ProgressTemplate>
                                                        </asp:UpdateProgress>
                                                        <asp:RequiredFieldValidator ID="rfvPCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="PostCode" ControlToValidate="txtPostCode"></asp:RequiredFieldValidator>
                                                        <asp:RegularExpressionValidator ID="revPCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="PostCode" ValidationExpression="[0-9]{6}"
                                                            ControlToValidate="txtPostCode"></asp:RegularExpressionValidator>
                                                        <asp:RequiredFieldValidator ID="rfvPostCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtPostCode"></asp:RequiredFieldValidator>
                                                        <asp:RegularExpressionValidator ID="revPostCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{6}"
                                                            ControlToValidate="txtPostCode"></asp:RegularExpressionValidator>
                                                    </div>
                                                    <div runat="server" visible="false" id="divAddressList">
                                                        <div class="h10">
                                                        </div>
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            Please choose your address
                                                        </div>
                                                        <asp:DropDownList ID="ddlAddressList" Width="320px" AutoPostBack="true" runat="server"
                                                            OnSelectedIndexChanged="ddlAddressList_SelectedIndexChanged">
                                                        </asp:DropDownList>
                                                    </div>
                                                </ContentTemplate>
                                            </asp:UpdatePanel>
                                            <div class="h10">
                                            </div>
                                            <div id="divUnitNo">
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Unit Number:
                                                </div>
                                                <asp:TextBox ID="txtUnit1" MaxLength="10" runat="server" size="8"></asp:TextBox>-
                                                <asp:RequiredFieldValidator ID="rfvUnit1" runat="server" CssClass="validationErrorControl"
                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtUnit1"></asp:RequiredFieldValidator>
                                                <asp:TextBox ID="txtUnit2" MaxLength="10" runat="server" size="8"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="rfvUnit2" runat="server" CssClass="validationErrorControl"
                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtUnit2"></asp:RequiredFieldValidator>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <asp:UpdatePanel ID="UpdatePanel2" runat="server">
                                                <ContentTemplate>
                                                    <div id="divPCAddress">
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Address:
                                                        </div>
                                                        <span id="divAddress"></span>
                                                        <asp:TextBox ID="txtAddress" runat="server" TextMode="MultiLine" MaxLength="120"
                                                            Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvAddress" runat="server" CssClass="validationErrorControl"
                                                            ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtAddress"></asp:RequiredFieldValidator>
                                                    </div>
                                                </ContentTemplate>
                                            </asp:UpdatePanel>
                                        </div>
                                        <div class="clear">
                                        </div>
                                        <div class="h10">
                                        </div>
                                        <div style="border: 1px solid #ccc; width: 912px; background: #d2d2d2;">
                                            <div class="h10">
                                            </div>
                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                Contact Info:</div>
                                            <div class="w190 note left">
                                                <span class="red">*</span> Mobile Number<br />
                                                <uc1:usrPhoneNo ID="txtMobileNo" IsEnabled="true" IsRequired="true" PhoneNoRequireErrorMessage="Require mobile number."
                                                    PhoneNoErrorMessage="Mobile phone number should 8 digits." PhoneNoValidErrorMessage="Invalid mobile phone number."
                                                    runat="server" ValidationGroup="travel_insurance" />
                                            </div>
                                            <div class="w190 note left">
                                                Home Phone Number<br />
                                                <uc1:usrPhoneNo ID="txtResidentialPhoneNo" runat="server" ValidationGroup="travel_insurance"
                                                    IsRequired="False" PhoneNoValidErrorMessage="Invalid home phone number." />
                                            </div>
                                            <div class="w190 note left">
                                                Office Phone Number<br />
                                                <uc1:usrPhoneNo ID="txtOfficeNo" runat="server" ValidationGroup="travel_insurance"
                                                    IsRequired="False" />
                                            </div>
                                            <div class="h10">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>

                                <script type="text/javascript">
                                    IncreaseProgress(40);
                                </script>

                                <div class="hilite" id="divTravellersInsured">
                                    <div class="top">
                                    </div>
                                    <div class="body_in pad_15x" id="divInsured">
                                        <h1>
                                            Insured Details</h1>
                                        <div class="seperator">
                                        </div>
                                        <div id="divIndividual" runat="server">
                                            <div class="w43per left">
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Name of Insured:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNameOfInsured" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNameOfInsured" runat="server" ControlToValidate="txtNameOfInsured"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Date of Birth:</div>
                                                    <div class="left">
                                                        <uc2:usrDate ID="usrDOB" runat="server" ValidationGroup="travel_insurance" IsRequired="True" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> NRIC/Passport number:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNRICPass" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNRICPass" runat="server" ControlToValidate="txtNRICPass"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <div id="divWithspouse" runat="server">
                                            <div class="w43per left">
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Name of Insured:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtInsured" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvInsured" runat="server" ControlToValidate="txtInsured"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Date of Birth:</div>
                                                    <div class="left">
                                                        <uc2:usrDate ID="usrDOBinsured" runat="server" ValidationGroup="travel_insurance"
                                                            IsRequired="True" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> NRIC/Passport number:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNRICPassInsured" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNRICPassInsured" runat="server" ControlToValidate="txtNRICPassInsured"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="w56per left">
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Name of Partner/Spouse:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtSpouse" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvSpouse" runat="server" ControlToValidate="txtSpouse"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Date of Birth:</div>
                                                    <div class="left">
                                                        <uc2:usrDate ID="usrDOBSpouse" runat="server" ValidationGroup="travel_insurance"
                                                            IsRequired="True" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> NRIC/Passport number:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNRICPassSpouse" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNRICPassSpouse" runat="server" ControlToValidate="txtNRICPassSpouse"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div style="display: none;">
                                                    <div>
                                                        <asp:TextBox ID="txtNRICwidSpouse" runat="server" Text="Valid"></asp:TextBox>
                                                        <asp:CustomValidator CssClass="validationErrorControl" ControlToValidate="txtNRICwidSpouse"
                                                            ValidationGroup="travel_insurance" ID="csvNRIC" ClientValidationFunction="Check2NRICValid"
                                                            OnServerValidate="Check2NRICValid" runat="server" ErrorMessage="Applicant IC/Passport and Spouse IC/Passport is the same."
                                                            Text=""></asp:CustomValidator>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <div id="divFamily" runat="server">
                                            <div class="w43per left">
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Name of Insured:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtInsuredFamily" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvInsuredFamily" runat="server" ControlToValidate="txtInsuredFamily"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Date of Birth:</div>
                                                    <div class="left">
                                                        <uc2:usrDate ID="usrDOBInsuredFamily" runat="server" ValidationGroup="travel_insurance"
                                                            IsRequired="True" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> NRIC/Passport number:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNRICPassInsuredFamily" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNRICPassInsuredFamily" runat="server" ControlToValidate="txtNRICPassInsuredFamily"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div style="display: none;">
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Number of children travelling:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNoOfChild" runat="server" Width="200px" Text="0"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNoOfChild" runat="server" ControlToValidate="txtNoOfChild"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                        <asp:TextBox ID="txtNoOfAdult" runat="server" Width="200px" Text="0"></asp:TextBox>
                                                        <asp:TextBox ID="txtNoOfTravellers" runat="server" Width="200px" Text="0"></asp:TextBox>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="w56per left">
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Name of Partner/Spouse:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtSpouseFamily" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvSpouseFamily" runat="server" ControlToValidate="txtSpouseFamily"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Date of Birth:</div>
                                                    <div class="left">
                                                        <uc2:usrDate ID="usrDOBSpouseFamily" runat="server" ValidationGroup="travel_insurance"
                                                            IsRequired="True" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> NRIC/Passport number:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNRICPassSpouseFamily" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNRICPassSpouseFamily" runat="server" ControlToValidate="txtNRICPassSpouseFamily"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div style="display: none;">
                                                    <asp:TextBox ID="txtNRICwithFamily" runat="server" Text="Valid"></asp:TextBox>
                                                    <asp:CustomValidator CssClass="validationErrorControl" ControlToValidate="txtNRICwithFamily"
                                                        ValidationGroup="travel_insurance" ID="cvNRICfamily" ClientValidationFunction="Check2NRICValidFamily"
                                                        OnServerValidate="Check2NRICValidFamily" runat="server" ErrorMessage="Applicant IC/Passport and Spouse IC/Passport is the same."
                                                        Text=""></asp:CustomValidator>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="clear">
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>

                                <script type="text/javascript">
                                    IncreaseProgress(50);
                                </script>

                                <asp:Panel ID="pnlAdultsParticulars" runat="server" Width="100%">
                                    <div class="hilite" id="divAdults">
                                        <div class="top">
                                        </div>
                                        <div class="body_in pad_15x">
                                            <h1>
                                                Additional Adult's Details</h1>
                                            <asp:Panel ID="pnlAdult1" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Adult 1</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divAdultName1">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtAdultName1" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvAdultName1" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtAdultName1"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revAdultName1" runat="server" ControlToValidate="txtAdultName1"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlAdultDOB1" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlAdultIdNumber1" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlAdult2" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Adult 2</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divAdultName2">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtAdultName2" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvAdultName2" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtAdultName2"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revAdultName2" runat="server" ControlToValidate="txtAdultName2"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlAdultDOB2" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlAdultIdNumber2" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                        </div>
                                        <div class="bottom">
                                        </div>
                                    </div>
                                    <div class="seperator">
                                    </div>
                                </asp:Panel>

                                <script type="text/javascript">
                                    IncreaseProgress(60);
                                </script>

                                <asp:Panel ID="pnlChildsParticulars" runat="server" Width="100%">
                                    <div class="hilite" id="divChilds">
                                        <div class="top">
                                        </div>
                                        <div class="body_in pad_15x">
                                            <h1>
                                                Child's Details</h1>
                                            <asp:Panel ID="pnlChild1" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 1</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName1">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName1" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName1" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName1"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName1" runat="server" ControlToValidate="txtChildName1"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB1" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber1" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild2" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 2</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName2">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName2" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName2" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName2"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName2" runat="server" ControlToValidate="txtChildName2"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB2" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber2" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild3" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 3</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName3">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName3" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName3" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName3"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName3" runat="server" ControlToValidate="txtChildName3"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB3" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber3" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild4" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 4</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName4">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName4" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName4" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName4"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName4" runat="server" ControlToValidate="txtChildName4"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB4" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber4" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild5" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 5</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName5">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName5" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName5" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName5"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName5" runat="server" ControlToValidate="txtChildName5"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB5" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber5" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild6" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 6</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName6">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName6" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName6" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName6"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName6" runat="server" ControlToValidate="txtChildName6"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB6" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber6" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                        </div>
                                        <div class="bottom">
                                        </div>
                                    </div>
                                    <div class="seperator">
                                    </div>
                                </asp:Panel>

                                <script type="text/javascript">
                                    IncreaseProgress(70);
                                </script>

                                <div class="hilite" style="display: " id="divPaymentModeHeader">
                                    <div class="top">
                                    </div>
                                    <div class="body_in pad_15x" id="divPaymentMode">
                                        <h1>
                                            Payment Mode</h1>
                                        <div class="seperator">
                                        </div>
                                        I / We authorised <b>EQ Insurance</b> to debit the premium amount due in connection
                                        with above insurance policy to my nominated Credit Card Account. Where a third party
                                        Credit Card is used, I declared that the cardholder has authorised and consented
                                        to its use.
                                        <div class="seperator">
                                        </div>
                                        <div id="divCreditcard" style="display: ;">
                                            <div id="divNameoftheCard">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Cardholder's Name:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtNameoftheCard" MaxLength="50" runat="server" size="25"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvNameoftheCard" ControlToValidate="txtNameoftheCard"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div id="divIssuingBank">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Issuing Bank:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtIssuingBank" MaxLength="50" runat="server" size="25"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvIssuingBank" ControlToValidate="txtIssuingBank"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div id="divCardNo">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Credit Card Number:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtCardNo1" runat="server" MaxLength="4" size="8"></asp:TextBox>
                                                    <asp:TextBox ID="txtCardNo2" runat="server" MaxLength="4" size="8"></asp:TextBox>
                                                    <asp:TextBox ID="txtCardNo3" runat="server" MaxLength="4" size="8"></asp:TextBox>
                                                    <asp:TextBox ID="txtCardNo4" runat="server" MaxLength="4" size="8"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvCardNo1" ControlToValidate="txtCardNo1" ErrorMessage=""
                                                        ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revCardNo1" runat="server" CssClass="validationErrorControl"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{4}"
                                                        ControlToValidate="txtCardNo1"></asp:RegularExpressionValidator>
                                                    <asp:RequiredFieldValidator ID="rfvCardNo2" ControlToValidate="txtCardNo2" ErrorMessage=""
                                                        ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revCardNo2" runat="server" CssClass="validationErrorControl"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{4}"
                                                        ControlToValidate="txtCardNo2"></asp:RegularExpressionValidator>
                                                    <asp:RequiredFieldValidator ID="rfvCardNo3" ControlToValidate="txtCardNo3" ErrorMessage=""
                                                        ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revCardNo3" runat="server" CssClass="validationErrorControl"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{4}"
                                                        ControlToValidate="txtCardNo3"></asp:RegularExpressionValidator>
                                                    <asp:RequiredFieldValidator ID="rfvCardNo4" ControlToValidate="txtCardNo4" ErrorMessage=""
                                                        ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revCardNo4" runat="server" CssClass="validationErrorControl"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{4}"
                                                        ControlToValidate="txtCardNo4"></asp:RegularExpressionValidator>
                                                    <asp:CustomValidator CssClass="validationErrorControl" ControlToValidate="txtCreditCardValid"
                                                        ValidationGroup="travel_insurance" ID="csvCreditCardValid" runat="server" ErrorMessage="Credit Card number not valid."
                                                        Text="" OnServerValidate="csvCreditCardValid_ServerValidate"></asp:CustomValidator>
                                                    <span style="display: none">
                                                        <asp:TextBox ID="txtCreditCardValid" Text="Valid" runat="server"></asp:TextBox>
                                                    </span>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div id="divCardExpiry">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Card Expiry Date:</div>
                                                <div class="left">
                                                    <asp:DropDownList ID="ddlCardExpiryMonth" runat="server">
                                                        <asp:ListItem Selected="True" Value="-1">mm</asp:ListItem>
                                                        <asp:ListItem Value="01">01</asp:ListItem>
                                                        <asp:ListItem Value="02">02</asp:ListItem>
                                                        <asp:ListItem Value="03">03</asp:ListItem>
                                                        <asp:ListItem Value="04">04</asp:ListItem>
                                                        <asp:ListItem Value="05">05</asp:ListItem>
                                                        <asp:ListItem Value="06">06</asp:ListItem>
                                                        <asp:ListItem Value="07">07</asp:ListItem>
                                                        <asp:ListItem Value="08">08</asp:ListItem>
                                                        <asp:ListItem Value="09">09</asp:ListItem>
                                                        <asp:ListItem Value="10">10</asp:ListItem>
                                                        <asp:ListItem Value="11">11</asp:ListItem>
                                                        <asp:ListItem Value="12">12</asp:ListItem>
                                                    </asp:DropDownList>
                                                    <asp:DropDownList ID="ddlCardExpiryYear" runat="server">
                                                    </asp:DropDownList>
                                                    <asp:RequiredFieldValidator ID="rfvCardExpiryMonth" ControlToValidate="ddlCardExpiryMonth"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" InitialValue="-1" Text=""
                                                        CssClass="validationErrorControl" runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RequiredFieldValidator ID="rfvCardExpiryYear" ControlToValidate="ddlCardExpiryYear"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" InitialValue="-1" Text=""
                                                        CssClass="validationErrorControl" runat="server"></asp:RequiredFieldValidator>
                                                    <asp:CustomValidator CssClass="validationErrorControl" ControlToValidate="txtCCExpiredValid"
                                                        ValidationGroup="travel_insurance" ID="csvCCExpiredValid" runat="server" ErrorMessage="Credit Card expire not valid."
                                                        Text="" OnServerValidate="csvCCExpiredValid_ServerValidate"></asp:CustomValidator>
                                                    <span style="display: none">
                                                        <asp:TextBox ID="txtCCExpiredValid" Text="Valid" runat="server"></asp:TextBox>
                                                    </span>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div id="divCardType">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Card Type:</div>
                                                <div class="left">
                                                    <span id="divVisa">
                                                        <asp:RadioButton onclick="ValCheckCardType();CheckCardTypeValidationCss();" ID="rdoVisa"
                                                            runat="server" GroupName="cardtype" />
                                                        &nbsp;<asp:Label class="pad_10xr" ID="lblVisa" runat="server" Text="VISA"></asp:Label>
                                                    </span><span id="divMasterCard">
                                                        <asp:RadioButton onclick="ValCheckCardType();CheckCardTypeValidationCss();" ID="rdoMasterCard"
                                                            runat="server" GroupName="cardtype" />
                                                        &nbsp;<asp:Label ID="lblMasterCard" runat="server" Text="MasterCard"></asp:Label>
                                                    </span>
                                                    <div style="display: none">
                                                        <asp:TextBox ID="txtCardType" runat="server"></asp:TextBox>
                                                    </div>
                                                    <asp:RequiredFieldValidator ID="rfvCardType" runat="server" CssClass="validationErrorControl"
                                                        Display="Dynamic" ErrorMessage="" ControlToValidate="txtCardType" ValidationGroup="travel_insurance"
                                                        Text=""></asp:RequiredFieldValidator>
                                                    <div class="clear">
                                                    </div>
                                                    <em class="note">(Only VISA or Master Credit Card is acceptable for premium payment)</em>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="seperator">
                                        </div>
                                        By signing this proposal form, I am aware that any refund will be paid by cheque
                                        the Insured/Policyholder. <b>EQ Insurance</b> will consider all declared information
                                        as true and correct. This Credit Card payment is subject to the terms of the Credit
                                        Card Agreement.
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>

                                <script type="text/javascript">
                                    IncreaseProgress(80);
                                </script>

                                <div class="norm" id="divDeclarationHeader">
                                    <div class="top">
                                    </div>
                                    <div class="body">
                                        <div class="pad_15x">
                                            <h1>
                                                Warranty and Declaration"</h1>
                                            <div class="seperator">
                                            </div>
                                            <div>
                                                <p>
                                                    Each and every person seeking to be insured warrants and declares that:</p>
                                                <div class="h7">
                                                </div>
                                                <p>
                                                    1) He/She is in good health and free from any physical impairment, infirmity, illness
                                                    or recurring illness.</p>
                                                <div class="h7">
                                                </div>
                                                <p>
                                                    2) He/She is not travelling against the advice of any medical practitioner or for
                                                    the purpose of obtaining medical treatment. &nbsp;&nbsp;&nbsp;&nbsp;<span style="cursor: pointer;"
                                                        onclick="showhide('divDeclaration');" class="form_i_cap">More Info
                                                        <img id='imgDeclaration' alt="Click to show/hide More Info" border="0" src="../../images/icons/sort_down.GIF" /></span></p>
                                            </div>
                                        </div>
                                        <div style="display: " id="divDeclaration" class="pad_15x">
                                            <div class="h7">
                                            </div>
                                            <p>
                                                3) He/She is unaware of any circumstance which is likely to lead to the cancellation
                                                or curtailment of the journey.</p>
                                            <div class="h7">
                                            </div>
                                            <p>
                                                4) He/She agrees to accept the terms, limitations, exclusions, conditions, clauses
                                                and warranties contained in the Policy and as modified or extended and agree that
                                                this application, declaration and any other information provided shall form the
                                                basis of the contract.
                                            </p>
                                            <div class="h7">
                                            </div>
                                            <p>
                                                5) None of the intended persons to be insured have already left Singapore on any
                                                trip meant to be covered by this EQ Travel Insurance.</p>
                                            <div class="h7">
                                            </div>
                                            <p>
                                                6) The information given and answers to questions in this application are true and
                                                correct to the best of his/her knowledge and have not withheld any facts likely
                                                to influence EQ Insurance Company Limited’s assessment of this application.</p>
                                            <div class="h7">
                                            </div>
                                            <p>
                                                7) He/She understands this application will be subject to the approval and acceptance
                                                by EQ Insurance Company Limited and the premium fully paid and received by EQ insurance
                                                Company Limited before cover can be effected.</p>
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>

                                <script type="text/javascript">
                                    IncreaseProgress(90);
                                </script>

                                <div class="seperator">
                                </div>
                                <div class="center align_center" id="divFormButtons">
                                    <asp:ImageButton ID="ibtSubmit" runat="server" ValidationGroup="travel_insurance"
                                        OnClientClick="LoadValidationErrorCss();CheckOptionValidationCss();" ImageUrl="~/images/forms_proposal/button/submit.png"
                                        OnClick="ibtSubmit_Click" class="button" />
                                    <asp:Label ID="lblMessage" runat="server" ForeColor="Red"></asp:Label>
                                    <div class="note">
                                        <img src="/images/forms_proposal/icon/warning.png" width="21" height="18" alt="Note"
                                            style="vertical-align: middle; padding-bottom: 3px" />
                                        <strong>Note</strong>, by clicking on the SUBMIT button you agree to our Website's
                                        <a href="../../terms/Terms.aspx" target="_blank">Terms &amp; Conditions</a>
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="bottom">
                        </div>
                    </div>
                </div>
                <div class="seperator">
                </div>
            </div>
        </div>
    </div>
    <div id="footer">
        <div id="nav_bottom" class="pad_7t">
            <div class="left pad_8yr">
                <a href="/travel-insurance/TAresultsquotesOne.aspx" onclick="return confirm('Are you sure to go back?');">
                    <img src="/images/forms_proposal/button/back.png" alt="Back" /></a>
            </div>
            <div class="right pad_8yr">
                <a href="#" onclick="window.print()">
                    <img src="/images/forms_proposal/button/print.png" alt="Print" /></a>
            </div>
        </div>
    </div>

    <script type="text/javascript">
        //<![CDATA[
        IncreaseProgress(100);
        HideLoading();
        //]]--> 
    </script>

    <script type="text/javascript">

        function ShowHideDiv(divName, varOnOff) {
            if (varOnOff) {
                document.getElementById(divName).style.display = "";
            }
            else {
                document.getElementById(divName).style.display = "none";
            }

        }


        function CheckOptionValidationCss() {
            CheckCardTypeValidationCss();

        }

        function CheckValidationCss(divYes, divNo, ctrlText, valCtrl) {
            ShowValidationEffectOption(divYes, divNo, ctrlText, valCtrl);
            return true;
        }

        function CheckValidationCssThree(div1, div2, div3, ctrlText, valCtrl) {
            ShowValidationEffectOptionThree(div1, div2, div3, ctrlText, valCtrl);
            return true;
        }


        function CheckCardTypeValidationCss() {
            CheckValidationCss('divVisa', 'divMasterCard', '<%=txtCardType.ClientID%>', '<%=rfvCardType.ClientID%>');
        }

        function ValCheckCardType(varOnOff) {
            var txtCtrl = document.getElementById("<%=txtCardType.ClientID%>");
            txtCtrl.value = "1";
        }

        function Check2NRICValid(source, arguments) {
            var ddlicpass = document.getElementById('<%=txtNRICPassInsured.ClientID%>');
            var appicpass = ddlicpass.value;

            var ddlspouseicpass = document.getElementById('<%=txtNRICPassSpouse.ClientID%>');
            var spouseicpass = ddlspouseicpass.value;

            var result = true;
            //alert(applicantNRIC + ' ' + spouseNRIC);

            if (appicpass == spouseicpass && appicpass != '' & spouseicpass != '') {
                result = false;
            }
            else {
                result = true;
            }

            if (result == false) {
                ddlicpass.style.backgroundColor = '#fcc';
                ddlicpass.style.border = 'Solid 1px #f00';
                ddlspouseicpass.style.backgroundColor = '#fcc';
                ddlspouseicpass.style.border = 'Solid 1px #f00';
            }
            else {
                ddlicpass.style.backgroundColor = '';
                ddlicpass.style.border = '';
                ddlspouseicpass.style.backgroundColor = '';
                ddlspouseicpass.style.border = '';

            }
            arguments.IsValid = result;
        }

        function Check2NRICValidFamily(source, arguments) {
            var ddlicpass = document.getElementById('<%=txtNRICPassInsuredFamily.ClientID%>');
            var appicpass = ddlicpass.value;

            var ddlspouseicpass = document.getElementById('<%=txtNRICPassSpouseFamily.ClientID%>');
            var spouseicpass = ddlspouseicpass.value;

            var result = true;

            if (appicpass == spouseicpass) {
                result = false;
            }
            else {
                result = true;
            }

            if (result == false) {
                ddlicpass.style.backgroundColor = '#fcc';
                ddlicpass.style.border = 'Solid 1px #f00';
                ddlspouseicpass.style.backgroundColor = '#fcc';
                ddlspouseicpass.style.border = 'Solid 1px #f00';
            }
            else {
                ddlicpass.style.backgroundColor = '';
                ddlicpass.style.border = '';
                ddlspouseicpass.style.backgroundColor = '';
                ddlspouseicpass.style.border = '';

            }
            arguments.IsValid = result;
        }

        function showhide(el) {

            el = document.getElementById(el);
            el.style.display = (el.style.display == "none") ? "block" : "none";

        }

        window.onload = function() {
            showhide('divDeclaration');
            //showhide('divPaymentMode');
            //showhide('divInsured');

            if (document.getElementById('<%=txtCardType.ClientID%>').value == "1") {
                ShowHideDiv('divPaymentMode', true);
            }
            else { ShowHideDiv('divPaymentMode', true); }

        }


        function restrictToNumbers(e) {
            if ([e.keyCode || e.which] == 8 || [e.keyCode || e.which] == 37 || [e.keyCode || e.which] == 9 || [e.keyCode || e.which] == 39) //this is to allow backspace
                return true;

            if ([e.keyCode || e.which] < 48 || [e.keyCode || e.which] > 57)
                e.preventDefault ? e.preventDefault() : e.returnValue = false;
        }

        function requestByPostCode() {
            try {
                var _pcode = document.getElementById('<%=txtPostCode.ClientID%>').value;
                if (_pcode.length != 6) {
                    alert('Postal code length must be 6 numbers value.');
                    document.getElementById('<%=txtAddress.ClientID%>').value = '';
                    return false;
                }
                else {
                    requestData(_pcode);
                }
            }
            catch (e) {
                alert(e.toString());
            }
        }

        function set_data(json) {
            try {
                var srcTable = $("#divAddress").empty();
                var txtAddress = document.getElementById('<%=txtAddress.ClientID%>');
                if (json == null) {
                    $("<table><tr><td>No address found!</td></tr></table>").appendTo(srcTable);
                    alert("No address found!");
                    document.getElementById('<%=txtPostCode.ClientID%>').value = "";
                    txtAddress.value = "No Address found.";
                    return;
                }
                if (json.length == 0) {
                    $("<table><tr><td>No address found!</td></tr></table>").appendTo(srcTable);
                    alert("No address found!");
                    document.getElementById('<%=txtPostCode.ClientID%>').value = "";
                    txtAddress.value = "No Address found.";
                    return;
                }

                var tbl = $("<table width='50%'>");

                var tbody = $("<tbody>");
                var no = 1;
                for (var i = 0; i < json.length; i++) {
                    var trow = $("<tr>"), rec = json[i];
                    if (rec.t != null) {

                        var ctn = rec.t + "<br>" + rec.a;

                        //$("<td>").text(no).data("col", 1).appendTo(trow);
                        $("<td>").html(ctn).data("col", 2).appendTo(trow);
                        if (i == 0) {
                            txtAddress.value = rec.t + "\n" + rec.a;
                        }
                        else {
                            txtAddress.value += "\n\n" + rec.t + "\n" + rec.a;
                        }
                        no++;
                    }
                    trow.appendTo(tbody);
                }
                tbody.appendTo(tbl);
                //alert(srcTable);
                tbl.appendTo(srcTable);
            }
            catch (e) {
                alert(e.toString());
            }
        }

        function PostCodeChange() {
            document.getElementById('divAddress').innerHTML = "Your postcode changed.";
            document.getElementById('divAddress').style.display = 'none';
            document.getElementById('<%=txtAddress.ClientID%>').innerHTML = "Your postcode changed.";
        }
        
    </script>

</asp:Content>
